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Houston Emergency Opioid Engagement System (HEROES)

A community-based program integrating assertive outreach, medications for opioid use disorder, behavioral counseling, peer recovery support, and paramedic follow-up

To increase accessibility to evidence-based care, Houston Emergency Opioid Engagement System (HEROES) is a program based at the University of Texas Health Science Center of Houston in collaboration with multiple community organizations including the Houston Fire Department, Houston Police Department, Houston Recovery Center, and Memorial Hermann Hospital as well as other public health and social service providers.

A quick response team, comprised of a paramedic paired with a peer recovery coach, use a data-driven outreach response. Information is used from emergency medical services (EMS) about individuals who have been revived with a naloxone intervention. In addition to post-overdose response in the emergency department (ED), the team provides active outreach to connect with these individuals, using motivational interviewing to establish rapport and to help individuals make a positive decision to start treatment and enter recovery. Same-day induction with buprenorphine in the ED is followed by the HEROES program linking the individual to more permanent, outpatient treatment with community providers. 

Overall aims of HEROES include:

  • provide comprehensive treatment for those with opioid use disorders
  • gain a more thorough understanding of the opioid crisis in Houston
  • develop a coordinated system of care
  • ultimately, to save lives

The program has been described in the peer-review literature along with preliminary results. The program has also been evaluated specifically based on its referrals from the criminal justice system. More information can be found in this news article. 

HEROES is primarily funded by the Texas Targeted Opioid Response program, which is funded by SAMHSA.

The program adapted to COVID-19 by rapidly enacting virtual care with telehealth for peer coaching, counseling, groups, and provider visits and reported an overall increase in patient engagement over time.

88% of participants still active in treatment after 30 days...assertive outreach could be a promising strategy to motivate people to enter and remain in long-term treatment. 

Continuum of Care
Treatment
Recovery
Type of Evidence
Peer-reviewed
Response Approach
COVID / Coronavirus related
Medications for Opioid Use Disorder
Outreach
Post-overdose response
Recovery coaching
Peer-reviewed Article
Outreach to people who survive opioid overdose: Linkage and retention in treatment
A Framework for EMS Outreach for Drug Overdose Survivors: A Case Report of the Houston Emergency Opioid Engagement System
Alternatives to Arrest for Illicit Opioid Use: A Joint Criminal Justice and Healthcare Treatment Collaboration
Telehealth sustains patient engagement in OUD treatment during COVID-19
Feasibility and outcomes from an integrated bridge treatment program for opioid use disorder
Related Resources
Guidelines for Medication for Addiction Treatment for Opioid Use Disorder within the Emergency Department
Recovery Coaches in Opioid Use Disorder Care
Peer Support Workers in Emergency Departments: Engaging Individuals Surviving Opioid Overdoses
A Scoping Review of Post Opioid-Overdose Interventions
Emergency Discharge Protocols for Patients with Substance Use Disorders and Opioid Overdoses in Maryland’s Hospitals
A Novel Social Work Approach to Emergency Department Buprenorphine Induction and Warm Hand-Off to Community Providers
Routes of Non-Traditional Entry into Buprenorphine Treatment Programs
Opioid Recovery Initiation: Pilot Test of a Peer Outreach and Modified Recovery Management Checkup Intervention for Out-of-Treatment Opioid Users
Hospitals’ Role in Addressing the Opioid Crisis: Buprenorphine in the Emergency Department
Emergency department screening and interventions for substance use disorders

Evidence of Program Effectiveness

This program is currently undergoing a clinical trial. 

Preliminary results from a peer-reviewed article: "We screened 103 individuals for eligibility, and 34 (33%) elected to engage in the treatment program, while two-thirds chose not to engage in treatment, primarily due to low readiness levels. The average age was 38.2 ± 12 years, 56% were male, 79% had no health insurance, and the majority (77%) reported being homeless or in temporary housing. There were 30 (88%) participants still active in the treatment program after 30 days, and 19 (56%) after 90 days. Given the high rates of relapse using conventional models, which wait for patients to present to treatment, our preliminary results suggest that assertive outreach could be a promising strategy to motivate people to enter and remain in long-term treatment." (Langabeer et al., 2020)

"Of the total 248 cases that the police department investigated related to overdose, 140 cases were non-fatal, allowing for follow up from law enforcement. Of these, the police contacted 104 (74%) of the individuals or their families. Twenty-four individuals who used opioids and who also met the other remaining program eligibility criteria stated they were motivated to make some changes in their opioid use behaviors and agreed to a treatment referral." (Yatsco et al., 2020)